May 2010 Volume 34 No. 5
Technology committee formed to review innovations

SHC and the Medical Staff have joined to form a Technology Assessment Committee (TAC) to review new technologies and innovations to ensure they are sound choices before they are implemented.

The committee, launched in March and expected to meet monthly, is co-chaired by Chief Medical Officer Kevin Tabb, Chief of Staff Bryan Bohman and by Arjun Rao, who was recruited from Massachusetts General Hospital, to lead SHC’s Clinical Effectiveness Program with Kevin Tabb and Kim Pardini-Kiely, vice president quality & effectiveness. At Mass General, Rao was involved in a similar technology assessment process.

Services and/or individuals can submit proposals to the committee whenever they contemplate adding major technologies or other significiant innovations to their hospital or clinic programs, Rao said.

Potential projects that are being assessed include ventricular assist device (VAD) destination therapy (Heartmate II), external VADs (Impela & Tandem Heart), intestinal transplant, TEG (Thrombelastography) machine, ECMO for ARDS patients, and patient ID technology.

In a letter to prospective committee members, Bohman wrote:

“The SHC status quo is that new technologies are often adopted, or not, based on a very ad hoc process which doesn’t necessarily include adequate informed consideration of all of the critical variables.

“This committee’s charge will be to identify new technologies (including diagnostics, therapeutics, and surgical or other therapeutic interventions or programs) before they are adopted de facto, and to assess the clinical value of these novel proposals in the context of other considerations such as financial variables and alignment with overall institutional values, priorities and resources.

“The committee will then advise as to whether to adopt the new technology/program (and if so, on what scale and timetable) and will follow up with re-assessment after an appropriate interval, usually a year later,” Bohman added. “We are, however, acutely aware of the need not to become a bottleneck in the process or to represent an obstacle to innovation. In fact, we hope that TAC approval will actually enhance expeditious approval of worthy proposals,” added Tabb.

Rao noted that a key task of the committee will be to consider Stanford-specific context when reviewing technology.

“For example, if a service wishes to install a particular robotic device, we would need not only to consider empirical evidence about its safety, efficacy and cost effectiveness, but we would need to know if the device would detract from experience needed by trainees at a teaching institution,” Rao said.

“But the driver will always be clinical need,” he added. “As a surgeon I understand the passion to incorporate new ideas and new tools into our practice, and in our enthusiasm, we sometimes lose sight of context.”

Committee members will include physicians and other leaders from hospital administration, the Medical School, quality improvement, risk management, finance, and ethics, and other areas as needed.

“We need people who are enthusiastic and knowledgeable regarding medical technological innovation but who can also be counted on to show some appreciation of financial and other institutional constraints and who will also show an appropriate level of skepticism for proposals with equivocal supporting evidence,” Bohman said.

For further information, contact Rao at ArRao@stanfordmed.org.